More Success Stories
An 87 year old Veteran contacted the OVO indicating that he requires a specific type of insulin that is not covered through the VAC drug plan. The client submitted a Doctor’s note indicating why he needed this specific type of insulin and was still denied reimbursement. We contacted VAC on his behalf, and asked why a fixed income Veteran with B coverage would choose to pay out of pocket for a non-formulary type of insulin unless he did indeed suffer serious side-effects from the listed types?
A Veteran had a TTY (teletypewriter) device installed during the early 1990s, which was required due to his pensioned condition for hearing loss. In 1996, he began writing and phoning VAC requesting they pay the monthly TTY bill. VAC denied his requests. We did a review of his file and encouraged him to appeal the initial decision. He appealed and partially won, with reimbursement back to April 2008. We encouraged him to go to a second level of appeal. In the meantime, we indicated to VAC that a total review of his file would be required to obtain a full understanding of this case.
This story is somewhat related to one of the hot issues that we listed last month. An 82 year old Veteran has taken the same route to his medical appointments for years because he feels that it is the safest route for him. VAC used to reimburse him based on his odometer reading. However, VAC has recently been reimbursing him based on the mileage calculated via Google Maps, which uses his home address and the address where his appointments take place to calculate the distance. Although he had written to VAC to advise that he took his route due to safety, but nothing had changed.
A Veteran was recommended light therapy by two physicians as treatment for a pensioned condition. VAC denied the coverage as the device was not on their benefits grid. Following discussion with the Department, it was found that a fair amount of evidence was available supporting this type of therapy. This in turn resulted in VAC amending their benefits grid to include this treatment. The treatment will now be covered for this Veteran.
We were recently successful in a case involving the grounds maintenance portion of VIP services. The Veteran had been denied hedge and shrub trimming based on policy, which we felt was being misinterpreted to the Veteran's disadvantage. According to regulations, the maintenance that is the responsibility of the client, and would normally be performed by him aside from his health condition, should be covered. After mediation and discussion with VAC the decision was reviewed and overturned, granting this client the services he needed.
In one instance, a Veteran's daughter contacted our Office because she was frustrated with delays in receiving reimbursement by VAC for her father’s long-term care expenses. We asked VAC if it was possible to set up direct billing with the facility to ensure a smoother process for all involved. VAC agreed and arranged for the facility to directly bill VAC. In addition, they will change all existing and new residents (Veterans) of this facility to direct billing.
In another instance, VAC denied a request from a Veteran for social transportation costs under the Veterans Independence Program. The reason for the decline was that although he was a pensioned veteran, he did not meet the income qualification. Upon review of his VAC file, we noticed his eligibility for the War Veterans Allowance for the purposes of treatment benefits. That eligibility, for all intents and purposes, identifies him as an income qualified veteran.